Provider Demographics
NPI:1801198379
Name:THOMAS LOBRANO DDS PA
Entity Type:Organization
Organization Name:THOMAS LOBRANO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECPT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-645-5388
Mailing Address - Street 1:260 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4200
Mailing Address - Country:US
Mailing Address - Phone:601-645-5388
Mailing Address - Fax:601-645-9187
Practice Address - Street 1:260 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4200
Practice Address - Country:US
Practice Address - Phone:601-645-5388
Practice Address - Fax:601-645-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1842791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1679668768OtherINDIVIDUAL NPI #
MS00064701Medicaid